Provider Demographics
NPI:1366770349
Name:AUSTIN, ABIGAIL LYNN (MA)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:LYNN
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:LYN
Other - Last Name:WENIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:581 SW 201ST AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-1500
Mailing Address - Country:US
Mailing Address - Phone:503-309-9688
Mailing Address - Fax:
Practice Address - Street 1:581 SW 201ST AVE APT 207
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-1500
Practice Address - Country:US
Practice Address - Phone:503-309-9688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-02
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61596669101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health